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May 2016Vol. 17, No. 3Reducing Rates of Psychotropic Medication Prescription

Children and youth in foster care are disproportionately prescribed psychotropic medications as compared to their peers not in care. A brief from the National Center for Youth Law (NCYL) examines the conditions and systemic factors that have led to this phenomenon, identifies promising interventions, presents case studies of State interventions, and offers policy strategies ranked by potential impact and ease of implementation.

The brief begins by giving some background on the problem of overmedication of children and youth in care, citing a Government Accountability Office report that indicates children in foster care are prescribed psychotropic medications at a rate 2.7 to 4.5 times higher than their peers who are not in care, as well as other studies showing the rate to be closer to 3.5 to 11 times higher. In 2011, Congress passed the Child and Family Improvement and Innovation Act, which required States to apply for particular Federal child welfare grants to create protocols for the use and monitoring of psychotropic medication prescribed to children in care. NCYL conducted interviews with child welfare administrators, medical directors, and other parties involved in improving oversight of psychotropic medication use in foster care in a number of States and discovered several shared approaches, including the following:

  • Utilization of Medicare claims data, pharmacy claims data, and/or electronic medical record systems to identify providers who prescribe above established thresholds and to flag children who receive potentially dangerous drug combinations and/or dosages
  • Prior authorization/hard edit processes requiring review of certain prescriptions and/or drug combinations
  • Second opinions/specialist consultation
  • Provider feedback, training, and corrective action
  • Enhancement of auxiliary psychosocial services

The brief concludes by offering general guidelines for States looking to address the issue of overmedication of youth in care, including the following:

  • Develop thorough data collection, analysis, and dissemination processes.
  • Use this data to inform provider education processes and specialist consultation triggers.
  • Develop prior authorization, second opinion, and provider outreach processes independent of data collection mechanisms.
  • Identify creative and cost-effective means to expand access to and utility of psychosocial interventions among foster youth.

To read the brief Curbing the High Rates of Psychotropic Medication Prescriptions Among Children and Youth in Foster Care, visit the NCYL website at